Treatment developed for patients with medically unexplained symptoms

The diagnosis of medically unexplained symptoms is a problem that affects millions of people and can tax an already over-burdened health care system, according to Robert Smith, a physician and professor in MSU's Department of Medicine, College of Human Medicine.

Smith and his colleagues devised the treatment plan which involves a combination of behavior modification and pharmaceutical treatment, as well as a good dose of improved communication between patient and doctor.

Testing this treatment with nearly 100 patients, Smith and colleagues found that nearly half of them showed marked improvement. The findings were published in the July issue of the Journal of General Internal Medicine.

"What we did was use what they've learned in psychiatry and the pain clinics, which is cognitive behavioral treatment and pharmacological treatment," Smith said. "We simply adapted it for use by primary care providers. But the centerpiece of all this is the doctor-patient relationship."

Medically unexplained symptoms can be frustrating for both patient and physician, Smith said.

"We're in a disease-based system and because of that fact, doctors don't particularly like patients with medically unexplained symptoms," he said. "On the other hand, patients are unhappy because their needs aren't being met."

This is where the value of the doctor-patient relationship comes into play, Smith said.

"For years we've taught our students the value of this relationship and it really works," he said. "It's about communicating, how to address emotion, how to respond to it, how to be empathetic. We integrated all of that into this treatment."

In addition to looking for the root causes of a patient's pain or discomfort, this treatment also calls for the use of medications such as antidepressants, as well as cognitive behavioral therapy that challenges the ways in which patients perceive their illnesses.

In this study, people with medically unexplained symptoms averaged 13 visits to primary care providers per year, many of those visits being to a hospital emergency room.

The most common symptoms are back pain, headache, fatigue, as well as musculoskeletal, nervous system and gastrointestinal complaints.

"Medically unexplained symptoms are common and costly," Smith said. "A patient's symptoms just won't go away, so a doctor orders more tests or gives more medicine or even operates on the patient. Pretty soon the patient will actually develop an organic disease as a complication of the drugs or surgery."

He said it's important that people who suffer from medically unexplained symptoms realize they are not going to be "cured."

"We can help to take the edge off," he said. "The patient may still have some pain, but it doesn't have to interfere with his or her life to the extent that it has in the past."